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Biomedical subjects

S O'Malley

Publications and source records attributed to S O'Malley.

71 records · Page 4Linked to original sources
PubMed1993

The costs and experiences of caring for sick and disabled geriatric patients--Australian observations.

The costs and experiences of caring for geriatric patients and the effectiveness of a geriatric assessment team have been reviewed in this study from the New South Wales Central Coast. The findings were: that some clients who are referred for placement in nursing homes and who meet standard criteria for admission can be maintained in the community; the cost to the taxpayer of persons admitted to nursing homes was at least $449 to $776 per week (1991 prices), compared to an average cost of $89 per week to maintain at home those whose original assessment met all the criteria for nursing home placement; assessments of needs of some clients were being conducted by five or more separate agencies which led to increased costs and created distrust and confusion for the client; a key factor in the decision to maintain a client in the community was found to be the availability and motivation of carers. A geriatric assessment team has an essential role in mobilising expert assessment and facilitates access to community-based support services to obviate or delay admissions to nursing homes.

Aged↗
PubMed1992

Contrast-enhanced MR imaging performed after successful lumbar disk surgery: prospective study.

A prospective study was undertaken to establish the normal spectrum and timing of gadolinium-enhanced magnetic resonance (MR) imaging findings in 15 patients who had resolution of symptoms after successful lumbar disk surgery. Enhancement of the facet joints (in 88% of disk levels) and paraspinal muscles (100%) decreased gradually after surgery. Enhancement of the decompressed nerve root tracked proximally toward the conus medullaris in 62% at 3 weeks and was absent in all by 6 months postoperatively. Areas of intermediate signal intensity with peripheral enhancement and mass effect were seen on T1-weighted images at the site of the original disk herniation in 38% at 3 weeks and 12% at 3 months, despite complete relief of leg pain. These results reveal that even in successfully treated (asymptomatic) patients, residual mass effect on the neural elements may frequently simulate a recurrent or residual disk fragment. There is an orderly progression of imaging changes during the first 6 months after lumbar surgery that limits the interpretation of MR examinations during that period.

Adult↗
PubMed1992

Neuropsychological impairment in chronic cocaine abusers.

Twenty chronic cocaine abusers were compared with age and education matched controls using standardized neuropsychological assessment procedures to determine whether the cocaine abusers were impaired. Fifty percent of the cocaine abusers in contrast to 15% of the controls scored in the impaired range on the summary index of the Neuropsychological Screening Exam. The cocaine abusers also performed more poorly on the Halstead Category Test, the Symbol Digit Modalities Test, the WAIS-R Arithmetic Test, and a test of verbal memory (forgetting). In the cocaine abuser sample, neuropsychological performance was related to the amount and recency of cocaine use, suggesting a direct role of cocaine on cognitive functioning.

Adult↗
PubMed1991

No association between an allele at the D2 dopamine receptor gene (DRD2) and alcoholism.

OBJECTIVE: --We attempted to replicate a positive allelic association between the A1 allele of DRD2 (the D2 dopamine receptor locus) and alcoholism that has been reported. DESIGN: --We compared allele frequencies at the previously described Taq I restriction fragment length polymorphism system of DRD2 in alcoholics and random population controls. SUBJECTS: --The alcoholic subjects were 44 unrelated white individuals, diagnosed by direct structured interview to have alcohol dependence (by the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, criteria). The subjects in our random population control group (N = 68) were also white. RESULTS: --For the control group, allele frequencies at DRD2 were 0.20 (A1) and 0.80 (A2). For the alcoholic group overall, allele frequencies were 0.23 (A1) and 0.77 (A2). There were no significant differences in allele frequencies at the DRD2 locus between alcoholics and controls. The allele frequencies in both groups agreed closely with those observed in most previously described control populations. Subtyping the alcoholic group according to presence or absence of family history of alcoholism, presence or absence of antisocial personality disorder, age of onset, presence or absence of physical withdrawal symptoms, or recent alcohol consumption (as a measure of severity) did not in any case reveal significant differences in allele frequencies. CONCLUSION: --We were not able to replicate the results previously reported. We conclude that our data do not support an allelic association between the A1 allele at DRD2 and alcoholism.

Adult↗
PubMed1988

Experience with a new topical anaesthetic in otology.

Producing good local anaesthesia of the external auditory meatus and tympanic membrane has always been a difficult problem facing otologists. Previously used methods are mentioned and the use of a new eutectic mixture of local anaesthetics (EMLA) for electrocochleography, myringotomy and grommet insertion in adults and older children is described. A double-blind controlled trial involving 15 patients (30 ears) undergoing electrocochleography showed EMLA to be a very effective, safe and convenient preparation for outpatient otological use.

Adolescent↗
PubMed1985

Activity of JM9 in advanced ovarian cancer: a phase I-II trial.

Thirty-nine patients with advanced solid tumors, including 28 with ovarian cancer, were entered in a phase I-II trial of a new platinum analog, JM9. Twenty-three patients had received prior chemotherapy which did not include cisplatin. Based on preliminary information from an ongoing study, our starting dose was 180 mg/m2. The total dose of JM9 was administered in 1 L of saline infused over 1 hour, with no additional hydration or electrolyte supplementation. Courses were repeated at 3-week intervals or after full recovery from thrombocytopenia. One hundred thirty-nine courses (range, one to six per patient) were administered at four dose levels: 180 mg/m2 (13 courses); 240 mg/m2 (64 courses); 300 mg/m2 (45 courses); and 350 mg/m2 (17 courses). The dose-limiting toxic effect was thrombocytopenia, which was dose-related and cumulative. Median platelet count nadirs were 50, 47, 25, and 28 X 10(9)/L for previously treated patients at dose levels of 180, 240, 300, and 350 mg/m2, respectively. For patients who had not received prior chemotherapy, the corresponding values were 403, 61, 44, and 36 X 10(9)/L. The nadir was predictable at Day 14 with recovery by Day 21 in earlier courses, but with delay of recovery to Days 28-42 in later courses and at higher dose levels. Twenty-five courses of chemotherapy in 15 patients were associated with a platelet count nadir of less than 20 X 10(9)/L, but despite this, serious hemorrhage was rare. Leukopenia was dose-related and mild; the median wbc count (X 10(9)/L) was 2.2 (range, 1.0-7.3) at the highest dose level of 350 mg/m2. The leukocyte count nadir was later than that for the platelet count (Days 21-28), and recovery was often not complete by the time of retreatment. All patients showed a progressive rise in mean corpuscular volume in successive courses, often accompanied by a fall in hemoglobin. Transfusions were required in 14 patients, 12 of whom had received prior chemotherapy. Nausea and vomiting, starting within 1 hour of drug administration, occurred in all patients, but appeared to be less severe and prolonged compared to that occurring with cisplatin. Diarrhea occurred in most patients at the two higher dose levels. There was no evidence of significant renal impairment, electrolyte disturbance, hearing loss, or peripheral neuropathy. Two patients had mild allergic reactions shortly after drug infusion and two others developed vasculitic rashes which were self-limiting.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMedDate not supplied

The relationship of patient difficulty to therapist performance in interpersonal psychotherapy of depression.

The efficacy of Interpersonal Psychotherapy (IPT) in the treatment of ambulatory major depression was demonstrated in the recently completed NIMH Treatment of Depression Collaborative Research Program (Elkin et al. 1986). Factors which enhance or impede the administration of the treatment delimit effective patient care and should therefore be understood. This report examines the relationship of pretreatment patient attitudes and in-treatment patient difficulty to the ability of therapists to competently conduct IPT, using data from a training program in IPT. The hypothesis was that the patient's ability and willingness to establish a relationship and undertake the task demands of therapy would influence the therapist's ability to administer treatment. Patient difficulty was found to be strongly related to both therapists' and supervisors' judgements of therapist performance during IPT sessions: when patients were more difficult, therapists were judged to have performed more poorly. Patients' preexisting negative expectations about the potential outcome of treatment were associated with patient difficulty and poorer therapist performance, while the level of presenting symptomatology was not. Thus, it appears that the patient's ability to engage in a productive therapeutic relationship rather than the severity of his presenting problems influenced the therapist's ability to competently perform IPT. The findings regarding the relationship of patient difficulty to ratings of therapist performance suggest that patient difficulty should be taken into account in assessing therapist competence, whether for studies of therapeutic efficacy or for clinical supervision and training in general.

Adult↗
PubMedDate not supplied

Initial motivations for alcohol treatment: relations with patient characteristics, treatment involvement, and dropout.

This study examines (a) the relation of initial treatment motivations to alcoholics' involvement in outpatient treatment and dropout and (b) the relations among patient characteristics, severity, alcohol expectancies, motivation, and treatment retention. A treatment motivation questionnaire (TMQ) was developed to assess both internalized and external motivations for treatment, as well as confidence in the treatment and orientation towards interpersonal help seeking. In Study 1, the TMQ was administered to 109 outpatients entering an alcoholism clinic. Based on these data the scale was revised and was administered to a subsequent sample of 98 subjects seeking treatment. Information about demographic variables, measures of substance use, alcohol expectancies, and psychiatric severity was also gathered. Eight weeks after intake, outcome was evaluated through attendance records and clinician ratings. Results revealed that internalized motivation was associated with greater patient involvement and retention in treatment. Subjects high in both internalized and external motivation demonstrated the best attendance and treatment retention while those low in internalized motivation showed the poorest treatment retention while those low in internalized motivation showed the poorest treatment response, regardless of the level of external motivation. Problem severity was also related to a greater degree of internalized motivation. The importance of initial motivations in understanding treatment response and dropout is discussed.

Adult↗
PubMedDate not supplied

Decline in intravenous drug use among treatment-seeking opiate users.

Opiate users seeking treatment during similar time periods in 1986 (n = 60) and 1988 (n = 82) did not differ significantly with regard to demographic factors, length of addiction, use of cocaine, history of alcohol problems, or indices of depression. In 1988, however, users reported significantly lower rates of current intravenous drug use than was reported in 1986: 39% in 1988, compared to 14% in 1986, reported not currently using IV (chi 2(1, N = 142) = 11.302, p < .001). For the combined periods, current IV users (n = 102) did not differ significantly from those who were not currently using IV (n = 40) with regard to demographic factors, size of habit, history of alcohol problems, or indices of depression. Current IV users had used opiates longer (mean 11.3 years versus 8.4 years; t(1, 65) = 2.20, p < .03), and there was a trend for cocaine use to be associated with current IV administration. For the smaller subset of those who survived waiting lists of between 1 to 4 months from the time of intake to program admission and physical examination (n = 81), 35% (6/17) of those who were not IV drug users at the time of clinic intake reported resuming or initiating IV drug use by the time of program admission. The validity of self-reports of not using IV at the time of program admission was assessed by comparison of self-report with findings of track marks on physical examination: inconsistencies were detected in 11% (1/9) of those whose self-reports indicated no current IV use.

Adult↗
PubMedDate not supplied

Naturalistic follow-up of drinking behavior following participation in an alcohol administration study.

Administration of alcohol to alcohol-dependent individuals for research purposes, while contributing significantly to the fund of knowledge on etiology and treatment of alcohol dependence, has often raised clinical and ethical concerns that such exposure may adversely affect the individual's motivation to reduce drinking or abstain from drinking. In an attempt to evaluate these concerns, we conducted a naturalistic follow-up of subsequent drinking among individuals who participated in an alcohol self-administration study and also received a brief motivational intervention. Twenty-one non-treatment-seeking alcoholics participated in a study examining the effects of naltrexone on alcohol self-administration. Assessment of drinking during the 3 months following the laboratory study indicated that participants had significantly reduced the total number of drinking days and the number of drinks consumed per occasion, as compared to baseline levels. The findings suggest that participation in alcohol administration research does not adversely influence the subsequent drinking of alcohol-dependent individuals. Further, when the alcohol administration research is conducted carefully, with specific attention to the clinical needs of the participants, the risks of adverse effects on participants' drinking behavior is minimal, and, in fact, there is scientific benefit to society and clinical benefit to the participants with regard to their alcoholism.

Adult↗
PubMedDate not supplied

Electrocochleographic changes in the hearing loss associated with X-linked hypophosphataemic osteomalacia.

Transtympanic electrocochleography was carried out on 13 patients (21 ears) suffering from X-linked hypophosphataemic osteomalacia, and known to have cochlear hearing loss. The majority of ears exhibited a cochlear pattern of cochleogram with a recruiting input/output function and a markedly biphasic action potential. In addition 14 ears yielded a greatly enhanced negative summating potential, suggesting the presence of endolymphatic hydrops. It is proposed that the hearing loss so frequently associated with this condition is in part due to endolymphatic hydrops.

Acoustic Stimulation↗
PubMedDate not supplied

Independent healthcare organizations band together to keep unwanted suitors at bay: are these alliances working?

Competitive pressures are forcing a growing number of independent health-care organizations to consider allying with local rivals to create a market presence capable of keeping mega for-profit competitors at bay. Such moves, however, do not reflect "just a for-profit versus not-for-profit thing," says one consultant. "This is life and death."

Economic Competition↗